Surgical Treatment Of Patients Research Articles

Serum Levels of Semaphorin 4C in Breast Cancer – Assessment of Prognostic Value and Potential for Monitoring Surgical Treatment Response

Abstract Introduction. The global burden of breast cancer (BC) has encouraged ceaseless research in exploring novel biomarkers, aiming to optimize BC management and prognosis. Objective. To explore the prognostic value of serum SEMA4C and investigate its potential for monitoring the response to surgical treatment in patients with BC. Materials and methods. Seventy-five (75) pre-treatment patients from the Clinic of Surgery with invasive BC without any initial treatment prior to blood sample collection were included in the study. The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of SEMA4C in human serum. Participants were divided based on pathological stage, nodal involvement and histological grade. Follow-up blood samples of 35 patients who underwent surgery were collected to investigate if SEMA4C could measure the response to surgical treatment. Results. Postoperative serum levels of SEMA4C were significantly lower than preoperative levels (p p < 0.001). Regarding prognostic value, no statistically significant difference was observed in terms of the pathological stage (p = 0.181), lymph node (LN) status (p = 0.752), and histological grade (p = 0.412). Conclusion. According to our study, serum SEMA4C levels did not differ significantly in terms of pathological stage, LN status and histological grade. Notably, postoperative serum levels of SEMA4C were significantly decreased after surgical treatment compared to preoperative values, which underscores the potential of SEMA4C as a putative candidate biomarker for monitoring response to therapy in patients with BC. However, additional research is mandatory to validate the role of SEMA4C in BC.

Surgical treatment of patients with varicose veins of the lower extremities from the origins to the present day

Varicose vein disease of the lower extremities is a common problem today. In various countries, approximately 25–30% of women and 10–15% of men sufferfrom this condition. Surgical methods hold a special place in the treatment of such patients. Currently, despite the development of effective minimally invasive endovenous techniques, doctors still face recurrences of the disease due to insufficiency of radical surgery, as well as the natural progression of varicose vein disease as genetically determined, which necessitates further exploration for solutions to improve treatment outcomes. The article describes the history of the development of surgical methods, including the first mentions of this disease, vessel ligation, phlebectomy, minimally invasive techniques, and others.

Surgical treatment of patients with gastric cancer of different age groups

Surgical treatment of patients with gastric cancer of different age groups

Is it possible to use colon stenting as part of the implementation of the early rehabilitation after surgery concept in the surgical treatment of patients with colon cancer complicated by obstructive intestinal obstruction? Review

Is it possible to use colon stenting as part of the implementation of the early rehabilitation after surgery concept in the surgical treatment of patients with colon cancer complicated by obstructive intestinal obstruction? Review

Predictive Factors for Surgical Decision Making in Nonconcussive Traumatic Brain Injury Patients without Immediate Surgery: A Propensity Score Matching Study of Optic Nerve Sheath Diameter, Glasgow Coma Scale, and Rotterdam Computed Tomography Score

To assess the utility of initial computed tomography (CT)-derived optic nerve sheath diameter (ONSD), Glasgow Coma Scale (GCS), Rotterdam CT score, and other factors in predicting subsequent surgical intervention in patients with non-concussive traumatic brain injury (TBI) who did not undergo immediate surgery. 251 adult patients (184 men, mean age 50.2 ± 17.7years) who had non-concussive TBI, initial head CT within 24 hours of trauma, and did not undergo immediate surgery were retrospectively included. Propensity scores utilizing age, sex and injury category matched 27 cases who ultimately had surgery within 48 hours of admission (surgery group) with 224 cases who did not (non-surgery group). Clinical and CT data were collected from medical and radiological records, including ONSD measurements performed by 3 radiologists, and compared between the two groups. All patients had non-concussive TBI with top three injuries including subdural, subarachnoid, and parenchymal hemorrhages in 165, 146, and 133 patients, respectively. ONSD differed between the surgery (mean 6.3 ± 0.8 mm) and non-surgery groups (mean 6.0 ± 0.7 mm, p = 0.014) only on a univariable analysis. Multivariable analysis revealed initial GCS of 9-12 and Rotterdam CT score >3 as predictive of surgery demonstrating odds ratios of 5.596 (2.031-15.421; p < 0.001) and 5.024 (1.823-13.847; p = 0.002), respectively. The initial GCS and Rotterdam CT score could anticipate the need for subsequent surgery among non-concussive TBI patients who did not undergo immediate surgery, whereas ONSD could not.

THE IMPORTANCE OF REMOVING THE INNER BOUNDARY MEMBRANE IN THE TREATMENT OF DIABETIC MACULAR EDEMA: A SERIES OF CLINICAL CASES

Vitreoretinal surgery (VRH) is recognized as the preferred method of treating diabetic macular edema (DMO), concomitant with additional pathology of the vitreomacular interface (VMI). Empirical data obtained as a result of numerous studies give contradictory results, therefore, the need for peeling of the internal limiting membrane (VPM) remains unresolved.Purpose. To find out the results of surgical intervention in patients with DMO as a result of epimacular fibrosis (EMF) by comparing cases with and without HPV peeling.Materials and methods. This manuscript presents a comparative assessment of three clinical cases. The patients had similar clinical manifestations and historical medical data. In all cases, patients underwent HRH for DMO combined with EMF. In two cases, the VPM was peeled, and in the third case, the VPM was preserved.Results. An analysis of the observational data and an assessment of anatomical and functional parameters revealed complications in the first and second patients at the late postoperative stage, while in the third patient the condition stabilized. Conclusion. The presented clinical cases show that anatomical and functional results are not always correlated. The increased risk of complications associated with a violation of the architecture and functionality of the retina during peeling requires a critical assessment of the clinical justification of this method.

DYNAMICS OF MORPHOFUNCTIONAL PARAMETERS OF RESISTANT DIABETIC MACULAR EDEMA AFTER SURGICAL TREATMENT

Anti-angiogenic injections are currently established as the «gold standard» for treating diabetic macular edema (DME). Vitreoretinal surgery is indicated in cases involving an epiretinal membrane or vitreoretinal traction syndrome. Some physicians consider it feasible to perform vitrectomy with the removal of the internal limiting membrane in patients with this condition.The objective of this study is to assess changes in the morphofunctional parameters of the retina in patients with resistant forms of DME who have undergone surgical intervention. At the N.I. Pirogov National Medical and Surgical Center, 75 patients diagnosed with DME unresponsive to conservative therapy (anti-vascular proliferation therapy, retinal laser coagulation) were operated on. All patients were divided into three groups based on the type of intervention.Evaluation of best-corrected visual acuity after surgery revealed a statistically significant improvement in this parameter among patients in the second and third groups compared to those in the first group six months post-operation. Patients in the third group showed a notable reduction in retinal thickness in the foveal area one month after the intervention. A significant decrease in edema was observed in patients from the second and third groups compared to those in the first group over the period from one month to one year. When assessing light sensitivity, a significant improvement in parameters was noted in patients from the second and third groups compared to the data from the first group one week after the surgery.The results confirm the high effectiveness of vitreoretinal surgical intervention in patients with resistant diabetic macular edema, affirming the possibility of selecting a surgical approach.

Sexual outcomes following the surgical treatment of traumatic rupture of the corpora cavernosa.

Penile fracture is a post-traumatic condition affecting the tunica albuginea of the corpora cavernosa when erect. Clinical diagnosis and urgent surgical intervention are crucial to avoid severe functional complications, particularly erectile dysfunction. We aimed to evaluate male sexual function after surgical treatment in patients with penile fracture and to identify predictive factors of postoperative erectile dysfunction. We underwent a hospital-based retrospective study on patients who underwent surgical repair for fractures of the corpora cavernosa between 2012 and 2023. Included in this study were all patients who have a postoperative follow-up of at least 12 months. Patients were clinically evaluated for the presence of erectile dysfunction and the presence of postoperative penile curvature. The patients were asked to answer the structured questionnaire of the International Index of Erectile Function (IIEF-15). We included 87 patients. The mean age was 38 ± 12years. Fourteen patients (16%) developed a fibrous plaque, with a median onset time of 30days postoperatively. Erectile dysfunction was noted in forty-four patients (51%). Active smoking (p < 0.002), the surgical approach (p = 0.02), a consultation time > 7.5h (p = 0.01), a length of the discontinuity of the corpora cavernosa > 2.5cm (p = 0.01) and the use of an erection inhibitor postoperatively (p = 0.021) were independent predictive factors of erectile dysfunction at 1 year postoperatively. Considering the results of our study, we propose rapid and urgent surgical management for penile fractures, and an elective surgical approach may be considered. We emphasize the fundamental role of sexual education, especially for young people, in preventing this sexual accident that could negatively impact their sexual life.

Study of the effectiveness factors of microsurgical treatment of cerebral arterial aneurysms

BACKGROUND: Despite improvements in diagnostic methods and microsurgical techniques for treating arterial aneurysms of the cerebral vessels, there remains a high probability of mortality and persistent disability among the working population. AIM: To determine the factors influencing the effectiveness of surgical interventions in patients with cerebral arterial aneurysms. MATERIALS AND METHODS: This scientific work presents the results of examination and surgical treatment of 86 patients operated on from 2017 to 2023 y. at the Neurosurgery Clinic of the National Hospital. The age of the patients ranged from 23 to 78 years (average age - 47±1.7 years), among them there were 48 (55.8%) men, 38 (44.2%) women. All patients underwent MRI or CT angiography of cerebral vessels; in 47 (54.6%) patients, cerebral aneurysm was confirmed by selective cerebral angiography. The size of the aneurysms ranged from miliary (3.0 mm to giant sizes 25.0-30.0 mm). RESULTS: The clinical picture of patients with ruptured arterial aneurysms was associated with the prevalence of subarachnoid hemorrhage, the location and volume of formed intracerebral hematomas in patients in the pre-hemorrhagic period with unruptured aneurysms - with the location and size of arterial aneurysms. One of the serious complications that arose during operations was intraoperative rupture (15.1%) of the aneurysmal sac at different stages of operations. The worst results with mortality up to 4.17% were observed in patients with ruptured arterial aneurysms, on the HH scale III, IV and 7-8, 9-10 points on the Glasgow scale. In cases where direct access to the aneurysm is difficult, it is advisable to perform subpial microresection of the altered medulla around the aneurysm. This allows you to avoid traumatic damage to the walls of the aneurysm and the development of spasm of arterial vessels. In order to avoid aneurysm rupture when isolating the aneurysm neck, it is advisable to temporarily apply special removable (temporary) clips to the proximal and distal segments of the supporting vessel of the aneurysm. After it was possible to isolate the neck of the aneurysm, a special clip was applied and, if possible, the patency and integrity of the vessel carrying the aneurysm and its branches were preserved. To determine the absence of blood flow in the aneurysm and assess the patency of arterial vessels, it is recommended to use intraoperative microvascular doplefography. CONCLUSION: The results of surgical treatment for ruptured aneurysms depended on the preoperative condition of the patients. Microsurgical clipping of arterial aneurysms effectively prevents the risk of recurrent subarachnoid hemorrhage. The absence of complications in patients during surgery and the early postoperative period does not guarantee the possibility of developing delayed complications that may require repeated operations.

Physical justification of the safety of using a surgical laser with a wavelength of 445nm during stapedoplasty

Abstract Introduction. Surgical lasers with different wavelengths are used in the surgical treatment of patients with otosclerosis. There are undoubted advantages of using surgical lasers during stapedoplasty at its various stages. At the same time, there is a risk of negative consequences for the structures of the inner ear due to the transition of light energy into thermal energy. Currently, the search for modern optimal surgical lasers for stapedoplasty continues. Aim ofthe study. To substantiate the safety of using a laser beam with a wavelength of 445nm during stapedoplasty using an experimental physical model. Materials and methods. Together with physicists from the Russian Engineering Club LLC, a physical experimental model was created to theoretically substantiate the use of a surgical laser with a wavelength of 445nm during stapedoplasty at its various stages. Results. Based on the physical calculations carried out during our study, we came to important conclusions regarding the effect of laser radiation on the structures of the inner ear during the stapedoplasty process. It was found that even if the value of the parasitic (damaging) radiation energy is 10 W (maximum value) with an average pulse duration used for perforation of the footplate of the stirrup is 0.15 s, then its effect will not lead to any significant thermal effect on the perilymph. Conclusions. The obtained data serve as a basis for further research and improvement of laser technologies in the field of otosurgery. As part of our study, we anticipate the need for additional histological analysis based on the results obtained. Despite encouraging findings regarding the safety of parasitic laser radiation in the context of thermal exposure to perilymph, histological examination represents an important next step for a deeper understanding of structural changes in the tissues of the inner ear.

Condylar Volumetric Asymmetry Predicts Need for Surgical Intervention in Patients With Cleft Lip and/or Palate.

In this study, the authors investigate the associations between the mandibular condyle and facial asymmetry in patients with cleft lip and/or palate (CLP). Condylar volume was calculated by measuring the bony volume of the posterior mandible superior to the sigmoid notch in skeletally mature patients with CLP and controls. Relationships between condylar asymmetry, facial deviation, and malocclusion were compared using t-tests, correlation analysis, and receiver operating characteristic curves. This study included 118 patients: 60 with CLP preparing for orthognathic surgery, 17 with CLP who did not undergo orthognathic surgery, and 41 controls. Condylar volumes in patients with CLP preparing for orthognathic surgery were more asymmetric than those with CLP not requiring surgery (16.4 ± 17.4% vs 7.1 ± 6.0%, P = 0.03). Patients with CLP who did not undergo orthognathic surgery and controls had similar degrees of condylar asymmetry (7.1 ± 6.0% vs 5.9 ± 3.8%, P = 0.35). Condylar asymmetry correlated with chin deviation (P < 0.01). Patients with CLP and clinically significant chin deviation (>4mm) had more asymmetric condyles than those without significant chin deviation, and the chin usually deviated toward the smaller condyle (P = 0.03). Condylar asymmetry >11% predicted undergoing orthognathic surgery in CLP with 70% sensitivity and 67% specificity. Condylar asymmetry is associated with facial asymmetry in patients with CLP, and the facial midline often deviates towards the smaller condyle. Condylar volumetric asymmetry in patients with CLP may be a predictor for needing orthognathic surgery, useful information for surgeons and families alike.

Photodynamic therapy – modern views and innovations in dentistry

Photodynamic therapy (PDT) consists of three elements: a photosensitizer, light and oxygen. The photosensitizer has the property of selective accumulation in target tissues without harming healthy cells. This innovative therapeutic method has already been successfully adapted in many areas of medicine, such as dermatology, gynecology, urology and oncology. PDT is also beginning to be introduced in dentistry. The antibacterial and fungicidal properties of the photosensitizer are used to achieve better results in the medical and surgical treatment of patients. Objective. To analyze current scientifi data on the application of photodynamic therapy (PDT) in various fi of dentistry, evaluate its effectiveness, and assess prospects for development. Materials and methods. A review of recent scientifi literature was conducted, including original studies, systematic reviews, and meta-analyses focused on PDT application in dentistry. Data on mechanisms of action, clinical efficacy, and new developments in PDT were analyzed. Results. High effi of PDT was established in the treatment of periodontal diseases, peri-implantitis, endodontic infections, and oral oncological diseases. Advantages of combined application of PDT with other treatment methods were noted. Promising directions for PDT development were identifi including the creation of new photosensitizers and technological innovations in equipment. Conclusions. PDT is a promising treatment method in dentistry, demonstrating high efficacyand safety. Further research is aimed at optimizing treatment protocols, developing personalized approaches, and integrating PDT with other modern technologies.

Augmentation cystoplasty in children with neuropathic bladder: long-term outcomes after 30 years experience.

Augmentation cystoplasty (AC) is a useful alternative for the treatment of neuropathic bladder, although there are few studies reporting long-term results. We assess our experience over the last 30-years. A retrospective study was conducted in patients with neuropathic bladder in whom AC was performed in our institution between 1990-2020. Demographic variables, pre- and post- AC urodynamic studies, long-term outcomes and postoperative complications were collected. Eighty-six patients (43 males and 43 females) underwent AC surgery with a median age of 12.8 years (interquartile range 9.6-15.1). Bladder augmentation was performed with ileum in 49 cases (57%), sigma in 32 cases (37.2%) and ureter in 5 cases (5.8%). In 27 patients an artificial urinary sphincter (AUS) was placed at the same intervention. The mean preoperative bladder capacity was 117 mL (SD 40), which was increased to 430 mL (SD 64) one year after surgery, this difference being statistically significant (P<0.001). Median follow-up was 24.5 years (interquartile range 17.5-26). Vesico-ureteral reflux improved after AC in 78.9% with no other surgical interventions. Seven mechanical complications associated with AUS were reported. Bladder lithiasis was reported in 9 patients. No bladder perforations were described. One patient developed bladder squamous cell carcinoma 16 years after AC, requiring radical cystectomy and Hautmann neobladder. Long-term results of this study demonstrate that AC is an effective surgical treatment in patients with neuropathic bladder patients without proper response to medical treatment. The risk of developing complications long after bladder augmentation makes close clinical follow-up of these patients essential.

Late-Term Outcomes of Surgical Treatment of Infective Endocarditis.

Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.

Trends in Ulnar Collateral Ligament Injuries and Surgery From 2010 to 2019: An Analysis of a National Medical Claims Database.

Ulnar collateral ligament (UCL) injuries have been on the rise for the past 3 decades. Current epidemiological studies on the incidence of UCL injuries have been limited to state or regional data. To utilize a large national claims database to determine the rates of UCL injuries and UCL surgical procedures over the past decade (2010-2019) and whether there has been a change in UCL surgical procedure patterns in the United States. Descriptive epidemiology study. The PearlDiver patient claims database was used to identify UCL injuries occurring from 2010 and 2019 that were sustained by male patients between 10 and 34 years of age. The study cohort was divided into 5 age groups (10-14, 15-19, 20-24, 25-29, and 30-34 years). Primary outcomes included the number of patients in each age group who sustained a UCL injury, the number of patients in each age group who underwent surgery, and the mean time from injury to surgery. A total of 19,348 UCL injuries occurred between 2010 and 2019, and 13% required a surgical intervention. Most of the injuries (54%) occurred in the 15- to 19-year group. Patients in the 20- to 24-year group were more likely to undergo surgery versus the 15- to 19-year group. Results demonstrated a trend toward delayed surgical interventions in patients in the 20- to 24-year group in the latter part of the decade. Data suggested that male patients <20 years account for the majority of UCL injuries, while male patients aged between 20 and 24 years are most likely to undergo surgery. Despite a number of targeted injury-prevention strategies and rule changes in sports, the UCL injury rate remained high. Therefore, there is a clear and present need to continue to develop UCL injury-prevention strategies for the younger population.

Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation.

The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases. Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis. In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow-up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively. In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure.

Intra-arterial chemoembolization as a component of neoadjuvant treatment of rectal cancer. Literature review

Interventional oncology is a rapidly evolving field of cancer treatment. Minimally invasive techniques, such as transarterial embolization with chemotherapeutic and radioactive agents, are common treatments and are found in many guidelines for the treatment of primary and metastatic liver lesions. It is known that the growth and development of a malignant neoplasm is primarily determined by angiogenesis. Rapid growth is ensured where the formation is directly related to the arterial bed. Therefore, when the drug is injected into the target vessel and providing tissue ischemia, it is possible to achieve a high degree of tumor pathomorphosis. This technique has an advantage for patients who, in some cases, cannot be treated surgically, and also increases the effectiveness of the chemotherapeutic effect. With the advent of necessary equipment in hospitals and the accumulation of experience in the use of minimally invasive interventions, it became possible to implement a new method of treating tumors of various localizations. In this review, we consider the results of domestic and foreign authors on the topic of intra-arterial chemoembolization before surgical treatment in patients with rectal cancer. It is noted that the analysis of the literature revealed a small number of works devoted to the chosen topic, despite the relevance of this problem for modern oncology.

A real-world evidence study of interhospital variability in the surgical treatment of patients with benign prostatic hyperplasia: the REVALURO study.

Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated with a high clinical, economic and humanistic burden. Several surgical techniques are available for the treatment of LUTS/BPH; thus, the aim of this study was to describe and explore the variability in the use of surgical procedures among Spanish hospitals. The REVALURO was a retrospective, observational study conducted by collecting data from the clinical records of patients with LUTS/BPH aged ≥ 35years, from 5 national reference hospitals, who were surgically treated between 2018 and 2022. Among the 3038 patients who underwent 3084 surgeries, 66% were invasive (2018: 57.5%, 2022: 71.5%), 22% were minimally invasive (MISTs) (2018: 20.7%, 2022: 20.2%) and 12% were highly invasive (2018: 21.8%, 2022: 8.4%). A total of 22.4% of patients' complications, with a maximum incidence of 28.6% (open prostatectomy) and a minimum 0.8% (water vapor thermal therapy (WVTT)] (p < 0.001). The reintervention rate was 1.5% over the study period. The median length of hospital stay after surgery increased from 0days (interquartile range [IQR]: 0) with WVTT to 5days (IQR: 4-8) with open prostatectomy (p < 0.001). Trends in surgical treatment showed that the use of invasive techniques increased, while the use of highly invasive techniques decreased, and the use of MISTs remained constant. However, given the heterogeneity among hospitals, national clinical guidelines and recommendations are needed to guide the decision on which technique should be used and to homogenize the criteria.

Machine Learning Predicts the Need for Surgical Intervention in Adhesive Small Bowel Obstruction.

To explore the predictive performance on the need for surgical intervention in patients with adhesive small bowel obstruction (ASBO) using machine-learning (ML) algorithms and investigate the optimal timing for transition to surgery. One hundred and six patients with ASBO who initially underwent long transnasal intestinal tube (LT) decompression were enrolled in this retrospective study. Traditional logistic regression analysis and ML algorithms were used to evaluate the risk of need for surgical intervention. Non-operative management (NOM) by LT decompression failed in 28 patients (26%). Multivariate logistic regression analysis identified a drainage volume ≥665 ml via LT on day 1, interval between ASBO diagnosis and LT intubation, and small bowel dilatation at 48 h after LT intubation to be independent predictors of transition to surgery (odds ratios 7.10, 1.42, and 19.81, respectively; 95% confidence intervals 1.63-30.94, 1.00-2.02, and 3.04-129.10; P-values 0.009, 0.047, and 0.002). The random forest algorithm showed the best predictive performance of five ML algorithms tested, with an area under the curve of 0.889, accuracy of 0.864, and precision of 0.667 in the test set. 97.4% of patients without transition to surgery (n=78) had passes of first flatus until three days. This is the first study to demonstrate that ML algorithm can predict the need for surgery in patients with ASBO. The guideline recommended period for initial NOM of 72 h seems to be reasonable. These findings can be used to develop a framework for earlier clinical decision-making in these patients.

Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and Cobb angles ranging between 40 and 50 degrees.

Patients with adolescent idiopathic scoliosis (AIS) are either managed with non-operative strategies or surgery depending on the severity of lateral curvature and impact on quality of life. However, supportive evidence for the appropriate treatment approach is lacking in AIS patients with Cobb angles between 40 and 50 degrees. Therefore, we investigated differences in long-term patient-centered outcomes in AIS patients with Cobb angles between 40 and 50 degrees who received either operative or non-operative management. A total of 919 patients aged 10-21years old with adolescent idiopathic scoliosis and 40-50 degree Cobb angles were identified from the HARMS Study Group (HSG) registry and dichotomized based on operative or non-operative management. Baseline and 2year follow-up SRS-22 scores from these patients were analyzed for significant differences between the total score values, domain values, and the magnitude of score change over time using multiple comparisons analyses. Multivariable regressions adjusting for age, body mass index, location of spinal deformity, and management strategy were also performed. Operative versus non-operative strategy was significantly, independently associated with differences in SRS-22 total and domain scores over time (effect likelihood ratio test, p < 0.03 for all regressions). Operatively managed patients had significantly greater improvement in SRS-22 total and domain scores over the follow-up duration compared to non-operatively managed patients (p < 0.02 for all comparisons). This preliminary analysis suggests that operatively managed patients may have had better long-term outcomes than non-operatively managed patients within this AIS subpopulation. These findings support the need for further prospective investigation to determine the optimal management strategy to improve evidence-based, patient-reported outcomes for AIS patients with Cobb angles between 40 and 50 degrees. Level III.